Clinical Interventions in Aging
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Age-related decrease in physical activity and
functional fitness among elderly men and women
Zoran Milanović 1
Saša Pantelić 1
Nebojša Trajković 1
Goran Sporiš 2
Radmila Kostić 1
Nic James 3
1
Faculty of Sport and Physical
Education, University of Niš, Niš,
Serbia; 2Faculty of Kinesiology,
University of Zagreb, Zagreb, Croatia;
3
London Sport Institute, Middlesex
University, London, UK
Correspondence: Zoran Milanović
Faculty of Sport and Physical
Education, University of Niš,
10a Carnojeviceva, Niš 18000, Serbia
Tel +381 63 739 9366
Email zoooro_85@yahoo.com
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http://dx.doi.org/10.2147/CIA.S44112
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O riginal R esearc h
This article was published in the following Dove Press journal:
Clinical Interventions in Aging
18 May 2013
Number of times this article has been viewed
Aim: To determine differences in physical activity level and functional fitness between young
elderly (60–69 years) and old elderly (70–80 years) people with the hypothesis that an age-
related decline would be found.
Methods: A total of 1288 participants’ level of physical activity was evaluated using the
International Physical Activity Questionnaire: 594 were male (mean ± standard deviation: body
height 175.62 ± 9.78 cm; body weight 82.26 ± 31.33 kg) and 694 female (mean ± standard
deviation: body height 165.17 ± 23.12 cm; body weight 69.74 ± 12.44 kg). Functional fitness
was also estimated using the Senior Fitness Test: back scratch, chair sit and reach, 8-foot up
and go, chair stand up for 30 seconds, arm curl, and 2-minute step test.
Results: Significant differences (P , 0.05) were found for all Senior Fitness tests between
young elderly (60–69 years) and old elderly (70–80) men. Similar results were found for the
women, except no significant differences were found for the chair sit and reach and the 2-minute
step test. From the viewpoint of energy consumption estimated by the International Physical
Activity Questionnaire, moderate physical activity is dominant. In addition, with aging, among
men and women older than 60 years, the value of the Metabolic Equivalent of Task in total
physical activity significantly reduces (P , 0.05).
Conclusions: This study found that the reduction in physical activity level and functional fitness
was equal for both men and women and was due to the aging process. These differences between
young and old elderly people were due to the reduction of muscle strength in both upper and
lower limbs and changes in body-fat percentage, flexibility, agility, and endurance.
Keywords: older adult, functional capacity, strength, aging
Introduction
According to the UN, the number of people older than 60 years increased by 2%
between 1950 and 2000 (from 8% to 10% of the total population). It is also expected
that the number of elderly people will increase to 22% of the total population by 2050,1
primarily due to increasing life expectancy. The average terminal age for men and
women in 1980 was 69.8 and 77.5 years, respectively, whilst in 2040 it is expected to
be 75.0 years for men and 83.1 for women.2 Effective approaches to help older people
maintain a healthy and active life are urgently needed, as the elderly have twice as many
disabilities and four times as many physical limitations as people less than 60 years of
age.3 In respect to the implications for maintaining independence and quality of life,
functional fitness as a function of age and physical activity (PA) was investigated.
Conceptually, functional fitness represents the physical capacity that is needed
to undertake normal everyday activities, independently and without the early onset
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which permits unrestricted noncommercial use, provided the original work is properly cited.
Milanović et al
of fatigue.4 However the aging process tends to reduce
physical fitness (strength, endurance, agility, and flexibility),
and results in difficulties in daily life activities and normal
functioning of the elderly.5,6 The level of daily activities
of elderly persons decreases with aging, although it is
well known that PA is important for independent living,7
prevention of chronic health problems,8 and quality of
life.9 Brach et  al10 demonstrated a significant relationship
between PA during a 14-year period and current functional
status in older women. Therefore, PA has a significant role
in maintaining functional fitness. If elderly individuals do
not take part in physically active lifestyles, they expose
themselves to the risk of their muscle mass and joint motion
reducing by 40% and 10%–40%, depending on body part,
respectively, while loss of muscle strength (∼30%) is related
to a decrease in muscle mass.4
Muscle mass and strength tend to reduce by 30%–50%
between the ages of 30 and 80 years,2 with the main cause
the reduction in the number of muscle fibers and atrophy
of type II muscle fiber.11 Furthermore, losses in muscular
strength occur at an approximate rate of 12%–14% per decade
after age 50 years.12 However, resistance training is generally
thought to be a promising intervention for reversing the loss
of muscle function and deterioration of muscle structure
associated with the aging process.12 Muscular function is not
the only deterioration associated with the aging process if
PA is not maintained. The cardiorespiratory system is also
susceptible to change, and significant decreases in aerobic
capacity have been found after the age of 40 years, such that
at the age of 65 years it has approximately 30% less capacity.4
This means that the capacity for elderly people to undertake
aerobic activities such as walking and running is adversely
affected by advancing age, due to the decline in maximal
oxygen uptake of about 0.5%–1.0% per year.13 Studies have
also shown that the number of falls increases by 35%–40%
after 60 years of age,14–16 which is a consequence of reduced
muscle strength, balance, and flexibility.
Whilst research is prevalent regarding the functioning of
older people generally, there are no published data regarding
either functional fitness or PA levels (intensity, duration, and
frequency) of elderly people in Serbia. Like many countries,
Serbia has seen an increase in the age of its population,
suggesting the need for this information. Additionally,
a study with a large sample size will be both representative
of the population and have high statistical power with the
influence of outliers or extreme observations limited.
The primary aim of this study was to determine
differences in PA level and functional fitness between
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young elderly (60–69 years) and old elderly (70–80 years)
people with the hypothesis that an age-related expected.
Cross-sectional data from a large sample representative of
the general population of men and women aged between
60 and 80 years was used.
Methods
Participants
A sample of 1288 participants, of which 594 were male
(46%) and 694 female (54%), was recruited from Southern
and Eastern Serbia, one of the five Serbian regions. A total
of 349 (27%) of the male participants were aged 60–69 years
and 245 (19%) aged 70–80 years, whilst 354 (28%) females
were aged 60–69 years and 340 (26%) aged 70–80 years.
General descriptive parameters are presented in Table 1.
The criteria for selecting participants were: age between
60 and 80 years; physically independent person, ie, able
to walk 20 feet without assistance or rest; and lack of
cognitive impairment and dementia, ie, achieved 24 points
for the educated or 18 points for the unqualified on the
mini-mental state evaluation. 17 The pharmacological
regime of the participants was also considered, and those
who were in the recovery phase of an acute illness and
the deaf or blind were excluded. Similarly, those with
cardiovascular system disorders identified through their
medical history or when completing the questionnaire were
excluded from participation, due to potential health risks
associated with the functional fitness tests. Participation
in the study was voluntary, and each of the participants
could withdraw from the study at any time. The study was
approved by the Research Ethics Committee of the Faculty
of Physical Education and Sport, University of Niš and
according to the Declaration of Helsinki. All participants
were fully informed of the potential risks and benefits of
this research.
Procedure
Each participant provided general demographic information,
the level of their PA using the International Physical
Activity Questionnaire (IPAQ), anthropometric measures,
and completed the Senior Fitness Test. Testing of all
participants took place between August and December
2011 by trained researchers. Interviews with potential
participants were undertaken individually or in small
groups at their homes or in activity centers for the elderly.
Participants underwent functional fitness tests between
9 am and 1 pm at an indoor centre where the air temperature
ranged from 22°C to 25°C.
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Table 1 Basic descriptive parameters (means ± standard deviation)
Men
60–69 70–80
n = 349 n = 245
Age (years)   63.9 ± 2.8   74.3 ± 3.1
Body height (cm) 176.3 ± 8.8* 174.5 ± 11.8
Body weight (kg)   82.3 ± 12.0*   82.6 ± 15.1
BMI (kg/m2)   26.6 ± 6.3   27.9 ± 2.7
Percentage of body fat (%)   30.1 ± 4.0*   31.9 ± 4.1
Note: *P , 0.05.
Abbreviation: BMI, body mass index.
Anthropometric measures
Anthropometric variables were measured according to
the guidelines of the International Biological Program.
Body height was measured to the nearest 0.1  cm by
a metric measuring tape. Body weight was measured
to the nearest 0.01  kg using a digital scale. Body
mass index (BMI) was calculated using the formula
BMI  =  body mass (kg)/(body height [m])2. Percentage
of body fat was calculated using the formula: adult body
fat % = (1.20 × BMI) + (0.23 × age) − (10.8 × sex) − 5.4.18
Senior Fitness Test
The Senior Fitness Test is a battery of tests for the assessment
of the functional fitness of older persons. This test assesses the
physiological capacity for carrying out normal daily activities
independently and safely without the appearance of fatigue.
Participants first undertook 10  minutes warm-up with
instructions given by a trained physical educator before the
test was completed in the designated order.19 Test validity has
been published by Rikli and Jones.20 The test consists of six
measures of functional fitness, as follows. (1) Back scratch,
to assess upper-body (shoulder) flexibility. Participants placed
one hand behind the same side shoulder with the forearm
pronated and fingers extended and the other hand behind the
back, fingers extended. After demonstration by the tester,
participants were asked to determine the preferred hand
placement and were given two practice trials, followed by two
test trials. The score was the number of centimeters the middle
fingers were short of touching (minus score) or overlapping
each other (plus score). The best score of the two test trials
was used to evaluate performance. (2) Chair sit and reach,
to assess the flexibility of the lower extremities. Participants
sat on the edge of a chair, with one leg bent and the other leg
extended straight in front with the heel on the floor. Without
bending the knee, participants slowly reached forward, sliding
the hands down the extended leg in an attempt to touch the
toes. After demonstration by the tester, participants were asked
Clinical Interventions in Aging 2013:8
Decrease of functional fitness in elderly people
Women
Total 60–69 70–80 Total
n = 594 n = 354 n = 340 n = 694
  67.7 ± 6.6   63.7 ± 2.9   73.9 ± 2.9   69.2 ± 7.8
175.6 ± 9.8 164.7 ± 6.5 166.5 ± 37.3 165.2 ± 23.1
  82.3 ± 31.3   70.6 ± 12.8   68.8 ± 11.7   69.7 ± 12.4
  27.0 ± 13.9   26.1 ± 4.9   25.5 ± 4.5   25.8 ± 4.7
  30.7 ± 4.1   40.2 ± 4.8*   41.8 ± 5.0   40.9 ± 4.9
to determine the preferred leg and were given two practice
trials on that leg, followed by two test trials. The score was
the number of centimeters short of reaching the toes (minus
score) or reached beyond the toes (plus score). The best score
of two test trials was used to evaluate performance. (3) Eight-
foot up and go, to assess agility/dynamic balance. To perform
this test, participants were fully seated in a chair, hands on
thighs and feet flat on the floor. On a signal, participants
stood from the chair, walked as quickly as possible around a
cone that was placed 8 feet (2.44 m) ahead of the chair, and
returned to a fully seated position on the chair. Participants
were told that this was a timed test and that the objective
was to walk as quickly as possible (without running) around
the cone and back to the chair. The result is the number of
seconds required to get up from a seated position, walk, and
return to a seated position. (4) Chair stand up for 30 seconds,
to assess lower-body strength. On a signal, participants rose
to a full standing position from a chair and then returned to
a fully seated position; they continued to complete as many
full stands as possible in 30  seconds. After demonstration
by the tester, a practice trial of one to three repetitions
was given, followed by one 30-second test trial. The score
was the total number of stands executed correctly within
30 seconds. (5) Arm curl, to assess upper-body strength. On
a signal, participants were instructed to flex and extend the
elbow of their dominant hand, lifting a weight (men, 8  lb
[3629 g] dumbbell; women, 5 lb dumbell [2268 g]) through
the complete range of motion, as many times as possible in
30 seconds. After demonstration by the tester, a practice trial
of one or two repetitions was given, followed by one 30-second
test trial. The score was the number of repetitions completed
within 30  seconds. (6) Two-minute step is an alternative
aerobic endurance test used when space limitations or weather
prohibits taking the 6-minute walk test. The result is the
number of full steps completed in 2 minutes, raising each knee
to a point midway between the patella (kneecap) and iliac crest
(top hip bone).
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Milanović et al
The intraclass correlation coefficients for test–retest
reliability for back scratch, chair sit and reach, and 8-foot up
and go were 0.90, 0.97, and 0.92 respectively.
International Physical Activity
Questionnaire
Self-evaluation of each participant’s PA level was ascertained
using the Serbian version of the IPAQ, the reliability of
which has been measured on the general Serbian population
aged over 60 years.21 The long version of the IPAQ was
used, which contains four domains of PA: work-related,
transportation, housework/gardening, and leisure-time
activity. Questions related to sitting and sedentary habits,
which were not pertinent to this research, were excluded from
analysis. For each domain, participants recorded the number
of days and time spent each day undertaking vigorous and
moderate-intensity activities separately along with the time
spent walking. These values (vigorous activity, moderate
activity, and walking) were used to calculate the PA levels, as
specified in the official IPAQ instruction manual. Similarly,
the Metabolic Equivalent of Task (MET) was calculated
for each domain separately (work-related, transportation,
housework/gardening, and leisure-time activity). Total
weekly PA level (MET minutes/week) was calculated using
separate MET values for each item using the following
coefficients: vigorous PA = 8.0 METs, moderate PA = 4.0
METs, and walking PA = 3.3 METs.
Vigorous activities are defined as activities in which
participants breathe more deeply than usual. These can
be activities such as lifting heavy things, digging, heavy
construction work, or climbing stairs. Moderate PAs are those
in which a person is breathing a little harder than usual and
may include activities such as carrying light loads. Walking is
not considered moderate PA. Vigorous and moderate activities
are those lasting for at least 10 minutes continuously.
Statistical analysis
SPSS version 18.0 (IBM, Armonk, NY, USA) was used for
the statistical analysis. Descriptive statistics were calculated
for all experimental data. Kolmogorov–Smirnov tests were
used to assess if data were normally distributed. Differences
in PA level and functional fitness between young elderly
and old elderly men and women were determined using one-
way univariate analysis of variance. Bivariate correlations
were computed using Pearson’s r for continuous variables
and Spearman’s ρ for categorical variables to examine the
relationship between functional fitness and PA level. Multiple
linear regression was used to examine any relationship between
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PA and functional fitness. Two models were examined for each
statistical analysis. Model A was adjusted for work-related PA,
transportation PA, housework PA, leisure-time PA, walking
PA, moderate PA, vigorous PA, and total PA. Model B was
additionally adjusted for age and sex. A Bonferroni correction
was used to adjust P-values for multiple comparisons.
Statistical significance was set at P , 0.05.
Results
The Kolmogorov–Smirnov tests showed that data were nor-
mally distributed. Participants in this study were 46% male
and 54% female, which is similar to the ratio of elderly men
and women in Serbia. Statistically significant differences
between young elderly and old elderly men were evident for
body height and weight and percentage of body fat (Table 1),
whereas women did not display these differences except for
percentage of body fat, which had increased significantly in
the old elderly compared to young elderly. Average values
of BMI showed that both men and women were overweight
(BMI . 25), regardless of age (60–69 or 70–80 years).
Senior Fitness Test
Eight-foot up and go, chair stand up for 30 seconds, arm curl,
and 2-minute step showed a statistically significant difference
(P  ,  0.05) between young elderly (60–69 years) and old
elderly men (70–80 years). Similar results were found in
women, except for the back scratch, chair sit and reach, and
2-minute step, where there were no statistically significant
differences (Table 2). These results suggest that upper-body
strength, as measured by the arm curl, had decreased by 8%
in men and 10% in women from age 60–69 to 70–80 years.
Similarly, lower-body strength (30-second chair stand) had
significantly decreased by 12% in men and 14% in women.
Agility (8-foot up and go) was also significantly lower in
men by 16% and women by 9%, whilst aerobic endurance
(2-minute step test) had decreased by only 1% (P = 0.66)
in women compared to 10% (P , 0.05) in men. Significant
decreases in functional abilities between the age categories
were found for flexibility of the upper limbs (back scratch) for
men and women, but for flexibility in the lower limbs (chair
sit and reach) men had significantly increased (P , 0.05)
their range of motion, whereas women had not changed
within this time frame.
International Physical Activity
Questionnaire
Men and women from both age categories reported total
PA levels that classified them as still being physically
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Table 2 Difference in the Senior Fitness Test parameters in men and women within age categories of 60–69 and 70–80 years (means ±
standard deviation)
Men Women
60–69 70–80 % 60–69 70–80 %
n = 349 n = 245 n = 354 n = 340
Back scratch (cm) -3.84 ± 5.26* -4.99 ± 6.04* -29 -2.41 ± 4.58* -3.66 ± 4.93* -51
Chair sit and reach (cm) -0.11 ± 9.86*   1.98 ± 11.57* 19   1.87 ± 10.95   2.05 ± 14.40 -9
8-foot up and go (seconds)   6.41 ± 1.44   7.46 ± 1.62* -16   6.67 ± 1.48   7.27 ± 1.42* -9
Chair stand up for 30 seconds (repetitions) 14.26 ± 5.53 12.51 ± 5.77* 12 13.75 ± 5.25 11.70 ± 5.15* 14
Arm curl (repetitions) 17.24 ± 6.27 15.76 ± 6.88* 8 13.67 ± 5.69 12.18 ± 6.51* 10
2-minute step test (repetitions) 95.06 ± 21.64 84.73 ± 24.24* 10 82.48 ± 26.19 81.68 ± 23.27 1
Note: *P , 0.05.

active (Table 3). In terms of energy consumption, estimated
by the IPAQ, moderate PA was dominant compared to
walking and heavy PA, and accounted for almost half the
energy consumed in both men and women, regardless of
age category. A significant difference (P , 0.05) between
young elderly and old elderly men was found for the domain
of PA at work, while other domains showed little difference.
However, in terms of total PA, the results indicated that there
was a significant decline (P , 0.05) in men from young to
old elderly in total walking MET. Women reported similar
patterns for their activity profiles to men, although their
MET values for total PA as well as work-time activity also
significantly (P , 0.05) reduced with age (Table 3).
Reported PA levels had weak correlations with the
fitness test results (range −0.14 to 0.24, Table 4). Multiple
linear regression analysis with PA in different domains
as independent variables showed that PA was associated
with 8-foot up and go (β = 7.020, P = 0.001), chair stand
up for 30 seconds (β = 12.503, P , 0.001), and arm curl
(β = 13.570, P , 0.001) (Table 5, Model A). Similarly, PA
was associated with back scratch (β = 0.207, P , 0.001),
8-foot up and go (β = 0.812, P , 0.001), chair stand up for
30 seconds (β = 28.233, P , 0.001), arm curl (β = 30.456,
P  ,  0.001) and 2-minute step (β  =  130.957, P  ,  0.001)
when adjusted for all covariates in Model A plus age and sex
(Table 5, Model B). Results showed an inverse relationship
that was not statistically significant between PA and upper-
body flexibility (Model A: β = −4.181, P = 0.20) or lower-
body flexibility (Model B: β = −5.728, P = 0.180).
Discussion
The level of PA typically decreased with age and was
associated with a decline in functional fitness. This research
confirms the assumption that the level of PA decreases
with the aging process, which in turn decreases men’s and
women’s functional fitness. These results tend to confirm
the observation that the level of PA is associated with the
maintenance or increase of physical fitness,5,22 and that any
kind of PA is better than inactivity.23,24
Generally, the results from this study have been in
accordance with previous research.25–29 For example, it has
been shown that upper-limb strength decreases with the aging

Table 3 Difference in International Physical Activity Questionnaire parameters in men and women within age categories of 60–69 and
70–80 years (means ± standard deviation)
Men Women
60–69 70–80 60–69 70–80
n = 349 n = 245 n = 354 n = 340
Total work-related (MET) 1184.39 ± 2827.13   472.85 ± 2021.24*   640.40 ± 2110.20   186.74 ± 965.63*
Total transportation (MET)   946.72 ± 2076.55   770.58 ± 1509.59   624.73 ± 1086.92   556.11 ± 1540.05
Total housework (MET) 1694.78 ± 2575.22 1704.87 ± 2689.73 2341.98 ± 2669.64 1998.57 ± 2813.38
Total leisure time (MET)   942.59 ± 1817.12   924.01 ± 2242.33   911.56 ± 2485.20   590.70 ± 1447.71
Total walking (MET) 1562.80 ± 2358.83 1036.21 ± 1971.33* 1200.37 ± 2075.23   895.25 ± 1995.18
Total moderate (MET) 2961.37 ± 4095.04 2599.64 ± 3708.18 3161.78 ± 3767.97 2346.77 ± 3341.84
Total vigorous (MET)   609.29 ± 1654.19   295.94 ± 1175.20   280.02 ± 1240.66   100.31 ± 575.91
Total physical activity (MET) 4503.43 ± 5583.49 3836.83 ± 5413.94 4327.81 ± 4922.84 3160.56 ± 4430.99*
Note: *P , 0.05.
Abbreviation: MET, Metabolic Equivalent of Task.

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Table 4 Bivariate correlations between physical activity level in different domains and functional fitness
Back Chair sit 8-foot up Chair stand up Arm curl 2-minute
scratch and reach and go for 30 seconds step test
Total work-related (MET) 0.028 -0.041 -0.019 0.016 0.079* 0.039
Total transportation (MET) 0.113* -0.002 -0.053 0.085* 0.108* 0.009
Total housework (MET) 0.041 0.038 -0.134* 0.106* 0.125* -0.026
Total leisure-time (MET) 0.020 -0.019 -0.100* 0.125* 0.192* 0.021
Total walking (MET) 0.097* -0.006 -0.093* 0.109* 0.177* 0.038
Total moderate (MET) 0.060 0.010 -0.139* 0.140* 0.188* -0.003
Total vigorous (MET) 0.002 -0.064* -0.003 0.033 0.094* 0.013
Total physical activity (MET) 0.098* -0.008 -0.123* 0.145* 0.235* 0.016
Note: *P , 0.05.
Abbreviation: MET, Metabolic Equivalent of Task.

process for both elderly men29 and women.28 This study found
the average reduction in muscle strength to be approximately
1% annually for both men and women, which is the same
as that found by Rantanen et al,26 whereas Bassey25 reported
an average loss of upper-arm strength of 2% per year for
221 British women aged 65 years and older. The consensus
opinion, therefore, for muscle-strength loss in elderly people’s
upper limbs seems to be between 1%–2% annually, for both
cross-sectional and longitudinal studies.28,29 However, after
the age of 75 years, muscle-strength decreases are likely
to be at an average of 3.4% annually unless this process is
slowed down through PA. Based on these findings, older men
and women could lose between one-quarter and one-third of
muscle strength over a 10-year period, which would make a
considerable impact on quality of life and ability to remain
independent from other people.
Muscle-strength loss has been shown to be greater for
lower limbs in comparison to upper limbs,30 a finding of this
research also. Male participants were shown to have lost 12%
of muscle strength for lower limbs and 8% for upper limbs at
ages 60–69 and 70–80 years. Similarly, elderly women lost
4% more strength in lower (14%) compared to upper limbs
(10%). Whilst this decrease in strength seems to be related
to increasing age and muscle-mass loss, it is also likely to
be a consequence of more physical inactivity.31 This was
confirmed by the IPAQ results, which showed that older
(70–80 years) people were less physically active in all seg-
ments (work-related, transportation, housework/gardening,
and leisure-time activity) compared to the younger (60–69)
ones, which would have an impact on muscle-strength loss.
The combination of muscle-strength loss, lower levels of PA,
and increased body fat as a result of the aging process repre-
sents the potential risk for decreased mobility,32 a situation of
relevance to the men and women involved in this study.
The rate of decrease of maximal oxygen consumption
(VO2max) is not constant throughout life, but has been shown
to accelerate significantly with each decade, and this decline
is greater in men than women.33–35 Hawkins and Wiswell36
suggested that aerobic ability loss is nearly 10% per decade,
which is similar to the results for the males in this study,
whereas the women had almost identical aerobic abilities.
Stathokostas et al35 found that men had higher initial VO2max
values than women, and their percentage decrease over
10 years was 14.7% compared to 7% for women between
55 and 84 years of age. The explanation given for this loss in
aerobic ability was the decrease in PA with age, seen in both
men and women, although the change in aerobic ability was
not the same between the sexes. Weiss et al37 suggested the

Table 5 Multiple linear regression models between physical activity and functional fitness
Dependent variable Model Aa Model Bb
β P-value Adjusted R2 β P-value Adjusted R2
Back scratch (cm) -4.181 0.020 0.012 0.207 ,0.000 0.048
Chair sit and reach (cm) 1.229 0.308 0.001 -5.728 0.180 0.003
8-foot up and go (seconds) 7.020 0.001 0.015 0.812 ,0.000 0.121
Chair stand up for 30 seconds (repetitions) 12.503 ,0.000 0.019 28.233 ,0.000 0.073
Arm curl (repetitions) 13.570 ,0.000 0.061 30.456 ,0.000 0.158
2-minute step test (repetitions) 86.871 0.952 0.003 130.957 ,0.000 0.054
Notes: aAdjusted for total work-related (MET), total transportation (MET), total housework (MET), total leisure time (MET), total walking (MET), total moderate (MET),
total vigorous (MET), and total physical activity (MET); badjusted for all covariates in Model A plus age and sex.
Abbreviation: MET, Metabolic Equivalent of Task.

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decrease in VO2max after 60 years of age was due to a drop in
maximum cardiac output, as well as a reduction in the arterial/
venous oxygen difference. These reductions take place more
rapidly in men than women, although sex differences tend to
vanish in the last decades of life.
In general terms, older elderly people (men and women)
tend to be less flexible than their younger counterparts, with
the greatest changes seen in this study for this ability with
women tending to be more flexible than men. After the age
of 60 years, women are 20%–40% more flexible than men,38
which was also found in this study.
Whilst aging is associated with a decrease in PA
and functional fitness, particularly after age 60 years,
regular PA can slow the rate of decline in both aerobic
and musculoskeletal systems and hence improve work
ability.39,40 Additionally, high levels of functional fitness and
PA were shown to reduce the risk of falling and suffering
injuries, whereas an increase in sedentary behavior results
in significant muscle-strength loss and an increase in
subcutaneous fat tissue. This study has shown that both men
and women become less and less active with the increase of
age, and hence this negatively affects their muscle strength,
endurance, and body structure.
This study involved a large number of participants aged
60–80 years and had consequently high external validity.
However, cross-sectional design, the indirect estimation
of PA levels via the IPAQ rather than pedometers or
accelerometers, and estimates of percentage body fat and
BMI using prediction equations instead of more accurate
measures, such as bioelectrical impedance, tend to lower the
study’s reliability and present study limitations. In future,
research studies should use direct methods for calculating
PA levels and body composition, as well as assessing the
influence of various types of PAs on the maintenance of
functional fitness of elderly people. Consideration should
also be given to longitudinal studies with several points of
measurement, as this would allow tracking and correction
for changes in PA and also allow more insight into the
relationship between PA, age, and physical fitness.
This study concluded that the reduction of PA and
functional fitness found in both men and women is due to the
aging process. Moreover, it was determined that aging results
in an increase in body fat, reduction of muscle strength in
both upper and lower limbs, and lower levels of flexibility,
agility, and endurance. These factors mean that the ability to
work and remain physically fit are compromised, particularly
in older compared to younger elderly people. Even though
the process of aging is natural and inevitable, an adequate
Clinical Interventions in Aging 2013:8
Decrease of functional fitness in elderly people
level of PA should slow down the loss of functional and
physical abilities and help maintain a healthy way of life
for elderly people.
Acknowledgment
This research is part of a project financed by the Ministry of
Science of the Republic of Serbia titled “Physical activity and
the fitness components of the elderly” (179056), approved
in 2010, which is being realized at the Faculty of Sport and
Physical Education of the University of Niš.
Disclosure
The authors report no conflicts of interest in this work.
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